{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABIGAIL   T HAYMORE","gend":1,"add":"101 YORK DR","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1999-01-25","age":"","mstatus":"","insh":"20028931*01","cliId":"","pno":"757\/454-6725","cno":"757\/454-6725","email":"","ename":"","eno":"","pphy":"OWUSU, NADA MD","ppno":"434\/799-2111","pcpadd":"STE 2100 201 S MAIN ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":133814,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R56.9","F43.10","F40.10","F41.9","E11.9","H40.053","Z20.828","G40.909","G47.9"],"date":["2021-04-29","2020-12-21","2020-12-21","2020-03-10","2021-06-11","2021-06-11","2020-12-29","2020-06-30","2021-04-29"],"priorHcc":["","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877026218","RIZATRIPTAN","10MG","6","Select","Select",""],["","17772010430","TROKENDI ","200MG","60","Select","Select",""],["","65862001205","SERTRALINE ","50MG","90","Select","Select",""],["","67877026218","RIZATRIPTAN ","10MG","6","Select","Select",""],["","68001040303","LEVETIRACETA ","500MG","60","Select","Select",""],["","00781531710","ZOLPIDEM ","5MG","30","Select","Select",""],["","87701040751","VITAMIN ","2000UNIT","90","Select","Select",""],["","68382003510","VENLAFAXINE ","75MG ER","90","Select","Select",""],["","23155050110","HYDROXYZ ","25MG","270","Select","Select",""],["","17772010430","TROKENDI","200MG","60","Select","Select",""],["","68001011707","LEVETIRACETA","500MG","60","Select","Select",""],["","65862001205","SERTRALINE","50MG","90","Select","Select",""],["","68382003510","VENLAFAXINE","75MG ER","90","Select","Select",""],["","00781531710","ZOLPIDEM","5MG","90","Select","Select",""],["","58487003711","VITAMIN","2000UNIT","90","Select","Select",""],["","42806016005","HYDROXYZ","25MG","90","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}